How the COVID Delta Variant Changes the Stakes

 As I tend to do when I'm worried about something, I've been reading up about the Delta variant of COVID-19. What does the emergence of this variant, which is outperforming all others today in terms of spread, mean for us? I have drawn two chief lessons. I share them here in case they are helpful.

LESSON 1: Not If but When.

The high transmissibility of the Delta variant means it is largely no longer a question of if you will get infected with COVID, but when. The remaining question is this: When you are infected, will your immune system be primed to fight off the disease quickly and efficiently—likely so quickly and efficiently that the virus is licked without you ever realizing you were sick? 

 It you are vaccinated, then the answer will be yes. If not, then the first time the virus enters your body, your immune system will be scrambling to figure out how to fight it. It may succeed--or, as has happened to too many people, it may flounder and go haywire in ways that jeopardize your life.

You will meet the Delta variant sooner or later. Its spectacular transmissibility pretty much guarantees that.

This means we are now in the situation of comparing head-to-head the health risks associated with getting the vaccine with the health risks of getting COVID. That didn’t used to be the case, at least not quite. Before the Delta variant came along, someone could reasonably say, “If I get the vaccine, I’m sure to face the risks associated with that. But if I don’t, I might never get COVID and so never face the risks associated with either one.” 

That is no longer true, unless you are capable of total isolation.

Of course, no vaccine is totally risk-free, but in a head-to-head comparison of vaccine vs. COVID risk, there really is no comparison. Both have been intensely studied by medical experts. For ordinary citizens, the chances of serious health complications from the vaccine is one in millions. The chance of serious health complications from COVID, if you're unvaccinated, is one in hundreds.

Put simply, from a health-risk standpoint getting COVID is many thousands of times worse.

There are few medical decisions these days where the difference between the options is so stark—similar in clarity to the choice between whether to have ice cream or someone else’s vomit for dessert. The only difference is that in the case of the ice cream vs. vomit, we don’t currently see loads of people playing up the risks of lactose intolerance while trying to make the vomit more appetizing by sprinkling hydrochloroquinine over it.

LESSON 2. We Mitigate Through Mandates or Face a Health Care System in Crisis

You might ask, if the Delta variant is so transmissible that everyone will be exposed eventually, why slow down the inevitable with mitigation measures like social distancing and mask-use? 

There are two answers. First, slowing down the rate at which people are exposed gives us more time to get more people vaccinated. It gives us more time to convince the vaccine-hesitant to get the shot before exposure—something that may save their lives. And it gives us more time to finish researching the impact of the vaccine on children under 12—potentially enabling us to protect our children with safe and effective vaccines before they catch COVID.

Second, given just how transmissible Delta is, if we do not collectively and consistently pursue mitigation measures in settings where transmission is likely--something that will likely only happen if we implement mandates on mask-use and social-distancing wherever transmission rates are significant--the virus will sweep through the vulnerable (that is, unvaccinated) population so quickly that we risk completely overwhelming our healthcare system. 

Delta spreads a LOT faster than earlier variants. A substantial vaccinated population--even as low as 50%--might have slowed the spread of other variants down enough to keep hospitals from being overwhelmed. But Delta is a different animal. Unless we take active steps to mitigate spread, it will find the unvaccinated quickly. It will spread among the unvaccinated quickly--especially if we bring bunches of them together in one place (such as grade schools where all the kids are under 12 and so cannot be vaccinated). The most vulnerable among them will need to be hospitalized. Some will need ICU care. Some will die. 

In states that actively preclude mitigation mandates, like Texas and Florida and Oklahoma, ICU beds (including pediatric ICU beds) are already at or near capacity. And that’s before the impact of the school year starting up (here in Stillwater, public schools started up two days ago and the university starts on Monday). Once schools are back in session, if we don’t implement mitigation measures like mask mandates things will get a lot worse a lot more quickly. 

And if you think mask-use will be extensive  and consistent if it is done on a wholly voluntary basis, without mandates, you might want to look around here in Stillwater, Oklahoma, today--and compare what you see with how things looked back before the mask mandates expired in May. Despite efforts to get the word out about the Delta variant and the new CDC guidance, mask use is...spotty.

Spotty masking won't do much good--especially if there is significant overlap between the unvaccinated and the unmasked. Remember, Delta is sweeping through the unvaccinated population, sickening the unvaccinated population, hospitalizing the unvaccinated population, killing the unvaccinated population. Those who are vaccinated can carry Delta to others...but are far less likely to. They can get seriously ill...but are far less likely to. 

Here's the problem. We've got two classes of people: those who take the pandemic seriously and trust the medical experts; and those who either don't take the pandemic seriously, don't trust the medical experts, or both. The former are very likely to have already been vaccinated--and they are very likely to take seriously a strong CDC recommendation to begin masking up in indoor public spaces. But it's the latter who, being unvaccinated, are vulnerable to the current wave of the pandemic--and hence the ones we really need to mask up to avoid a health care crisis. Unfortunately, it is also the latter group that is least likely to mask up voluntarily based on guidance from medical experts--because, for whatever reason, they don't trust those experts.

Of course, some of that latter group will resist mask use even if it is mandated. But mandates still have an effect. Last academic year, all my students wore masks in class, even those who didn't believe it was necessary. They wore the masks because that was the rule. Mandates increase mask-use, and widespread and consistent mask-use--especially among those who are unvaccinated--is a crucial tool in slowing the spread of Delta through unvaccinated populations and thus keeping hospitals from becoming overwhelmed.

An overwhelmed health care system means everyone has less access to lifesaving treatment—whether they’re sick with COVID or something else. An overwhelmed health care system means that doctors and nurses who are already overworked and emotionally exhausted find themselves pushed past the break point.

We’re talking about a health care system in which the human beings who are called to fight this war suffer such serious burnout they can’t continue. And like a kind of feedback loop, an already overburdened system becomes even more overburdened as people burn out and the weight falls heavier on those who remain.

This was a risk before the Delta variant came along, and was a major basis for the decision to shut the country down. Now the Delta variant is in play, with viral loads a thousand times higher than earlier strains and transmissibility rates many times higher. Unless we mandate mitigation measures like indoor mask-use, we will quickly reach a healthcare crisis once Delta starts to spread in schools. 

If the crisis gets bad enough, we won't be talking about mandating masks in schools. We'll be talking another shutdown. And we'll be burying too many beloved dead.

Love your unvaccinated neighbors--by getting vaccinated and wearing a mask.

Love your local health care workers--by getting vaccinated and wearing a mask.

Love yourself--by getting vaccinated and wearing a mask.

The Straw Man Fallacy, the Principle of Charity, and Deflection Tactics: The Case of Florida Governor DeSantis

Earlier today, Florida Gov. Ron DeSantis lashed out at a reporter who asked him if mask mandates might have helped seven children in Florida who are currently in intensive care with COVID.

DeSantis responded with the following words: "You're blaming the kids, saying they weren't wearing masks so they're in the ICU. With all due respect, I find that deplorable to blame the victim who ends up being hospitalized."

With all due respect, Gov. DeSantis, I doubt very highly that the reporter was blaming the kids who are in the ICU for their illness. A far more charitable reading of the question is that the reporter was blaming you.

Actually, since DeSantis is unlikely to ever read this blog post, let me stop talking to him directly. The point I want to make here is that there are strategies for engaging in public discourse about controversial topics that are likely to advance mutual understanding and help make progress in reaching wiser collective decision. And then there are strategies that have the opposite effect. DeSantis's response to the reporter falls into the latter category. Often, such deliberate muddying of the water is meant to deflect attention when someone faces a challenge they are ill-equipped to answer directly--and that is almost certainly what is happening in this case.

Let's go a bit deeper, in order to see why. The reporter asked a question. Let me paraphrase it as follows: 

Seven children are severely ill with COVID. The state of Florida does not have masking mandates--in part because Gov. DeSantis is an ardent opponent of such mandates. Would some or all of those seriously ill children have been spared if there had been state-wide mask mandates of the sort DeSantis opposes?

These are not the reporter's precise words, but I think they capture the substance. So what is the reporter really saying here? Philosophers advocate using what they call "the Principle of Charity" in interpreting what others say: if what someone says can be taken in different ways, opt for the interpretation that makes the most sense. Partly this is about choosing the interpretation that is the best fit with their actual words and (since we sometimes fumble for the words or don't quite say what we obviously mean) with their likely intentions to the extent that we can discern them. Partly, also, it is about assuming the best about others when that is possible: if there is a way of understanding what someone says that is plausible and morally decent, then don't choose an interpretation that is wildly implausible or that attributes to them views or aims that are indecent.

The Straw Man Fallacy might be seen as the polar opposite of the Principle of Charity. The Straw Man Fallacy involves attributing to someone a view or position that is at best a distortion of what they have said and at worst foists on them an easily-refuted or outrageous view they would never endorse but which bears enough superficial resemblance to what they actually said that you can get away with making the false attribution. In short, it's about attacking someone for some implausible or indecent view they don't hold and then acting as if you have successfully refuted what they said. 

Rather than a means of trying to engage with the substance of another's words, the Straw Man Fallacy is often a deflection tactic. Sometimes, the aim is to turn the conversation away from the actual ideas someone raised because you aren't sure you can refute them and you want to give the appearance of having won the debate--and since the distortion is easy to refute, you can create that appearance by attacking it. At other times, you use a Straw Man to deflect because the actual ideas the other person has expressed have merit...and if that is noticed it could be bad news for you.

It is no surprise at all that politicians routinely commit the Straw Man Fallacy and ignore the Principle of Charity. But am I right that DeSantis's response to the reporter is a case of this?

Consider. The reporter asked a question. It would be entirely reasonable to treat it not as a veiled act of casting blame or criticism, but as simply a question: Would a different policy have had better results for pediatric health in Florida than the policy DeSantis has been championing? Usually, there is no violation of the principle of charity when you treat something formulated as question as if it were an honest question. Had DeSantis engaged with this question, he might have given his reasons for thinking either that (a) a different policy wouldn't have had better results or (b) even though it might have had better public health outcomes, other considerations (perhaps the freedom of individuals to avoid the inconvenience of a bit of cloth on their faces) is more important that the survival of the state's children. 

Of course, if he tried to make either case (a) or (b) he'd be forced to engage with strong arguments to the contrary. Of the two, he comes out better if he defends (a)--but in that case, he'd invite experts around the country to marshal arguments and evidence that strongly challenge the truth of (a).

Another interpretation of the reporter's question falls within the scope of plausibility and might be seen as allowed by the principle of charity, namely the interpretation I posited above: the reporter's question was a veiled criticism of the governor. The reporter was, in the form of a question, really saying that those critically ill children would have been less likely to have ended up in the ICU if DeSantis had championed a different public policy response to the COVID crisis in his state, perhaps one that included a mask mandate in indoor public spaces.

Had DeSantis interpreted the reporter's question in this way, if he didn't want to accept blame for making an unwise public health choice he could either (again) defend the wisdom of his favored public policy by defending (a) or (b)--or to concede that a mask mandate would have had better outcomes for the state but maintain that he can't reasonably be held blameworthy for choosing an alternative course, perhaps because of unavoidable ignorance or something to that effect. In states where mask mandates were lifted before the delta variant surge, I could imagine a public leader offering such a response: "We sincerely believed that vaccinations had brought the virus sufficiently under control that masking was no longer doing enough good to justify the intrusion into personal choice and public convenience." 

But DeSantis's broader policy choices and leadership decisions could render such a move implausible, forcing him to defend (a) or (b). And if he didn't think he had a sufficiently compelling case for either (a) or (b), he might therefore have chosen to deflect with a Straw Man--not because that serves the truth or the public good, but because that serves his own ego and political prospects.

Is that what he did? The answer depends on how plausible it is to take the reporter as, in effect, saying, "The children who are in the ICU are to blame for their own condition, because they failed to wear masks." Is this a plausible reading of the reporter's question about whether a mask mandate would have spared those kids? Or, if not that, is it an implication of what the reporter was asking, even if he may not have noticed that implication?

Clearly it is neither. Here are some things to keep in mind, things that DeSantis surely knows:

1. Children in public spaces are more protected by the widespread mask-wearing of those around them than they are by their own mask-wearing. Such widespread mask-wearing is more likely to happen when there is a mask mandate. Hence, a widespread mask mandate could reduce the incidence of pediatric COVID independent of the mask-wearing habits of the children themselves. 

2. Since younger children, being immature and lacking adult self-control, will predictably fall short in diligent mask-wearing, it falls on the broader society to protect those kids from their understandable failures through adult diligence. In other words, a society that knows kids will be safer if either the kids wear masks diligently or the adult population wears masks diligently, and which knows that kids being kids will fall short in wearing masks diligently, has reason to buckle down and diligently wear masks for the safety of those kids. So, a mask-mandate could help protect children from their own immaturity by driving home with the force of law the importance of adult diligence in protecting children through adult mask-wearing. And the evidence shows that, in fact, mask-wearing among adults is more diligent and widespread when there are legal mandates. So, again, a mandate could reduce risk to children regardless of what the children do--and, in fact, may be wise precisely because we cannot expect young children to diligently wear masks. 

3. Kids cannot be expected to wear masks at home, and so they are vulnerable to being infected by family members who bring the virus home. But mask mandates reduce the rate of virus spread within a community, such that it is less likely that a family member will bring the virus home, exposing the child, in a community with a mask mandate than in a community without one. Again, for this reason a mask mandate protects children regardless of the mask-wearing habits of the children themselves.

In short, a mask mandate is the sort of thing that can reasonably be expected to protect children from the spread of COVID, reducing their risk of getting it and being hospitalized, regardless of whether the children themselves consistently wear masks. Not only has DeSantis surely been presented with this information, but so has the reporter. It is, after all, widely disseminated public knowledge, at least among those of us who have been following the research on masking and COVID. 

As such, it is almost certainly this information that motivated the reporter's question. If the reporter were making an accusation (not merely asking a question) it is therefore highly unreasonable to suppose that the reporter were accusing the sick *children* of failing to mask up. It is much, much more plausible to treat the reporting as accusing state leaders (and DeSantis specifically) of failing to make a public policy decision pertaining to mask use that would have predictably reduced the risk to those children.

DeSantis surely knew that the reporter was not blaming children for being sick. He surely knew that there is a difference between talking about masking policies and individual mask use. The reporter specifically referenced the former. And when you are focusing on policies, it is primarily political leaders who are responsible for whether those policies are implemented or not--not sick kids who might have not gotten sick had the policies been different. 

So, DeSantis was guilty of committing the Straw Man Fallacy and ignoring the principle of charity. And if you ask me, he probably did it on purpose as a deflection tactic, because he was not ready to defend himself against the charge that he'd made and was continuing to make a bad public health policy decision at a time of unprecedented risk to public health. 

There are likely many who see those children in Florida ICU's are a vivid symbol of DeSantis's blundering of this public health crisis. He likely knows this. So when the reporter called attention to this symbol of public health incompetence, out of fear of the political ramifications he accuses the reporter of blaming innocent children for their own illness--even though that is not what the reporter did. 

I sure hope that most people see through this move and continue to push for substantive discussion of public policy questions, and continue to ask whether state leaders who have been resisting mask mandates should rethink their positions as the delta variant surges in states like Florida (and my own state of Oklahoma). Let's demand actual engagement with these questions and not fall for Straw Man deflections.